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Presented by Alexander Truskinovsky, M.D. and prepared by Anil Parwani, M.D.,Ph.D
Case 6: 26 year old woman with infertility and a 4 cm ovarian mass
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1. Question
Week 131: Case 6
26 year old woman with infertility and a 4 cm ovarian mass/images/4703case6fig1.jpg
/images/4703case6fig2.jpgCorrect
Answer: Steroid cell tumor
Histology: Section show a well circumscribed mass composed of large cells with clear to foamy cytoplasm and small uniform nuclei. The neoplastic cells are arranged in solid sheets with intervening fibrovascular septa. The tumor showed strong, diffuse immunostaining for inhibin and focal staining for Melan-A. Immunostains for EMA, cytokeratin, and RCC (renal cell carcinoma marker) were negative.
Discussion: The mean age of the patients who develop this tumor is 43 years. 50% of the tumors are androgenic; others secrete estrogen, progesterone, aldosterone, cause Cushing’s syndrome, hypercalcemia, erythrocytosis, and ascites. Grossly steroid cell tumors can be
yellow, orange, brown, or black. 25-43% are malignant. Criteria for malignancy include 2 or more mitoses/10 HPF, necrosis, diameter over 7 cm, hemorrhage, and grade 2 or 3 nuclear atypia.Incorrect
Answer: Steroid cell tumor
Histology: Section show a well circumscribed mass composed of large cells with clear to foamy cytoplasm and small uniform nuclei. The neoplastic cells are arranged in solid sheets with intervening fibrovascular septa. The tumor showed strong, diffuse immunostaining for inhibin and focal staining for Melan-A. Immunostains for EMA, cytokeratin, and RCC (renal cell carcinoma marker) were negative.
Discussion: The mean age of the patients who develop this tumor is 43 years. 50% of the tumors are androgenic; others secrete estrogen, progesterone, aldosterone, cause Cushing’s syndrome, hypercalcemia, erythrocytosis, and ascites. Grossly steroid cell tumors can be
yellow, orange, brown, or black. 25-43% are malignant. Criteria for malignancy include 2 or more mitoses/10 HPF, necrosis, diameter over 7 cm, hemorrhage, and grade 2 or 3 nuclear atypia.
